Community Resilience in the Eye of a Storm

When Hurricane Harvey hit Houston in 2017, officials from Harris County Public Health had to get creative. Here’s how they kept Houstonians healthy in the wake of the storm and what they learned in the process.

One year ago, in August 2017, Hurricane Harvey made landfall and then refused to leave. Hovering over Harris County, Texas—home to Houston—it dumped 1 trillion gallons of water, the equivalent of 40 million swimming pools, on the county’s 1,778 square miles. One community saw 10 inches of rain in 90 minutes. Drainage systems—all systems for that matter—failed or were disrupted in unfathomable ways. Water was as high as streetlights in some places. Potentially poisonous chemicals and dangerous bacteria surged through residential areas. People were trapped by flooded roads. Homes and lives were destroyed.

Those 10 days—from August 25 when the storm made landfall until September 4 when the sun finally returned—were some of the most challenging of Umair A. Shah’s career. Umair A. Shah, MD, MPH, is a physician, an emergency responder, and most importantly the executive director of Harris County Public Health (HCPH). HCPH is the county health department for the 3^rd largest county in the nation serving 4.7 million people. He and his staff were in rapid response mode leading up to the storm, during the storm itself, and for several weeks in the recovery phase of the storm, often operating 24/7.

During a visit to the Robert Wood Johnson Foundation (RWJF), I had the pleasure of discussing Harris County’s response with Dr. Shah. “My staff came every day to do their jobs,” he told me, “while they too wondered about their own homes or how their family members were faring. I am so amazed by their absolute dedication to the needs of our community despite it all.” Dr. Shah himself drove 2,200 miles in 10 days visiting neighborhoods that were heavily impacted from the storm.

While surveying the damage, Dr. Shah was also reminding Harris County residents of how to stay safe after the storm. He informed them of a newly formed fleet of HCPH mobile outreach “Health Villages” that his department set up where they could get vaccines, food, and cleaning supplies. Dr. Shah offered some pearls of wisdom he has taken from the experience that he hopes to share with others working in public health. Here are the four major lessons:

Lesson 1: Take Public Health to the Public

Hurricane Harvey ravaged many homes, neighborhoods, and stores, leaving families without basic supplies. To address their needs Dr. Shah and his team took services directly to them. “We knew our communities, especially the most vulnerable, were not mobile so we simply had to be mobile for them,” he said. “Our tagline was ‘taking public health to the public.’”

Teams went door-to-door and fast-tracked a fleet of recreational vehicles (RVs)—outfitted as “Health Villages"—that they had planned to unveil later in the year. One of the RVs functioned as a roving mosquito museum that had been created for Zika virus prevention. It offered insect repellant and educated people (especially children) on how to reduce mosquito breeding sites. Others handed out food donated by the food bank and cleaning supplies along with information on how to properly clean mold. There were also PlayStations^®, which turned out to be a big draw for kids as well as a chance to discuss immunizations and health screenings with parents.

Other “Health Villages” had pet microchipping stations and offered vaccinations for cats and dogs. “[N]ot everyone thinks of their own health,” Dr. Shah said, “but they do think of their pet’s health.” Once there, the public health team could talk about many other public health issues: proper clean-up, how to protect against E.coli, how to cope after a disaster and other health concerns that residents faced after the disaster. The team also produced short “one-minute” videos on a variety of topics and uploaded them to YouTube. Which led to lesson #2.

Lesson 2: Communicate and Engage

Dr. Shah believes social media is the “public health communication tool of tomorrow that is available to us today.” In addition to YouTube, Dr. Shah’s team used Twitter, Facebook, Instagram, and other platforms to get the word out about safety, updates and response activities. They also used social media to put out calls for assistance. When hand sanitizers were not available through the official response channels, Dr. Shah’s team tweeted directly at corporate Twitter handles. Wal-Mart, H-E-B, and Whole Foods stepped up as did others. Grocery stores, local restaurants and the faith community, they all came to the rescue after calls went out on social media, Dr. Shah said.

“We’d say on Twitter, we need X and then the private sector would show up. We also monitored social media to see what was going on with people, what their needs were,” Shah said. “We’d find there’s an issue in this part of town, let’s connect our services to the identified needs.” It was often bidirectional communication, he said, which is when he recognized that “if we’re thinking about building the public health of tomorrow, we have to engage. We have to use traditional and social media alike.”

Social media allowed Dr. Shah and his team to focus both on immediate needs and raise the visibility of public health. “It truly comes down to what I call the 3 V’s of public health. When you raise the visibility, you have a chance at demonstrating the value of our work. And once you show the value, the 3^rd V kicks in: validation. Validation by folks wanting to invest in the work resource-wise or through pro-health policies. It has worked for our department and though we are talking about emergencies here, indeed we have learned the 3 V’s go well beyond emergency response,” said Dr. Shah. 

Traditional broadcast media and radio were also critical elements that HCPH used to share their community’s story. They kept communicating with local and national media about the needs of their community. And, in turn they communicated important health information to the community itself. They advised people to use appropriate personal protective equipment during their clean-up efforts, reminding them not to swim in stagnant water, and telling residents to take care of their mental health.

The news cycle happens 24/7 and it was important to remind the world continually that even though the rain had ceased, the recovery process was far from over. Sharing the stories of community is important because it gives visibility to the often-unnoticed work of public health.

Lesson 3: It Takes a Village; Call on Partners

We often say, public health can’t do it alone, yet we continually try. It’s critical to leverage relationships from across county government and within the community. HCPH has an excellent relationship with all Harris County departments including the Harris County Office of Homeland Security and Emergency Management (HCOHSEM) that led the overall county emergency response. These internal partnerships are critical before, during, and after disasters. Hurricane Harvey was truly an ‘all-governmental’ response to a singular disaster.

Dr. Shah and his team also drew on community groups, nonprofits, volunteers, philanthropy, and the private sector. “We put them all into the mix,” he said. Doing so, they were able to bring more resources together and serve community needs more effectively. “The health department served as a key convener of others who could also help in the complicated health puzzle that the disaster created,” he said. “We were able to draw on strengths of each organization, and where there were limitations, we could lean on each other and fill those limitations by working together.” Leaders should be creating and nurturing these relationships year around, because you never know when you may need their help or are called upon to help them instead.

Lesson 4: Be Resilient; Plan for the Unknown

“We talk about ‘vulnerable populations’ but the truth is we’re all vulnerable,” Dr. Shah said. We’d be smart to plan for that vulnerability, when the sun is shining, before the disaster. And we must remember just because you just had a big storm doesn’t mean you can’t have another. The reality is we just don’t know when or where the next disaster will hit.”

Harris County, he said, is rebuilding better and rebuilding smarter. Dr. Shah and his team are leveraging existing partnerships while working with new partners whom they intersected with in the midst of the emergency. Since Harvey’s waters have receded, they’ve all been asking: How do we rebuild better? How do we create a more resilient, thriving community?

“Harris County and Houston were previously thriving, but there were challenges,” Dr. Shah said. “Strangely enough, Hurricane Harvey gives us the opportunity to tackle these challenges head-on. But we have to go beyond the last disaster, the last emergency. How is our community set up for tomorrow? We as a health agency have to drive that in some places, and just be at the table in others. The 3 V’s of public health matter. That’s doing our part. And when we do it together, that’s how community—all of our community—thrives.”   

Every state has unique strengths and weaknesses when it comes to health security. Check out the National Health Security Preparedness Index to see how your state is doing and to learn more about what it can do to improve.

About the Author

Paul Kuehnert, former associate vice president–program for the Robert Wood Johnson Foundation, provided leadership and management direction for the Foundation’s work related to leadership and transforming health and healthcare systems.